What Causes Calcific Tendonitis and How Is It Treated?
What is calcific tendonitis?
Calcific tendonitis (or tendinitis) occurs when calcium deposits build up in your muscles or tendons. Although this can happen anywhere in the body, it usually occurs in the rotator cuff.
The rotator cuff is a group of muscles and tendons that connects your upper arm to your shoulder. Calcium buildup in this area can restrict the range of motion in your arm, as well as cause pain and discomfort.
Calcific tendonitis is one of the most common causes of shoulder pain. You’re more likely to be affected if you perform a lot of overhead motions, such as heavy lifting, or play sports like basketball or tennis.
Although it can usually be treated with medication or physical therapy, you should still see your doctor for diagnosis. In some cases, surgery may be necessary. Keep reading to learn more.
Tips for identification
Although shoulder pain is the most common symptom, about one-third of people with calcific tendonitis don’t experience any noticeable symptoms. Others may find that they’re unable to move their arm, or even sleep, because of how severe the pain is.
If you do feel pain, it’s likely to be in the front or back of your shoulder and into your arm. It may come on suddenly or build up gradually.
That’s because the calcium deposit goes through three stages. The last stage, known as resorption, is considered to be the most painful. After the calcium deposit has fully formed, your body begins to reabsorb the buildup.
What causes this condition and who’s at risk?
Doctors aren’t sure why some people develop calcific tendonitis and others don’t.
It’s thought that calcium buildup may stem from:
- genetic predisposition
- abnormal cell growth
- abnormal thyroid gland activity
- bodily production of anti-inflammatory agents
- metabolic diseases, such as diabetes
Although it’s more common in people who play sports or routinely raise their arms up and down for work, calcific tendonitis can affect anyone.
This condition is typically seen in adults between 40 and 60 years old. Women are also more likely to be affected than men.
How is it diagnosed?
If you’re experiencing unusual or persistent shoulder pain, see your doctor. After discussing your symptoms and looking over your medical history, your doctor will perform a physical exam. They may ask you to lift your arm or make arm circles to observe any limitations in your range of movement.
After your physical exam, your doctor will likely recommend imaging tests to look for any calcium deposits or other abnormalities.
Once your doctor has determined the size of the deposits, they can develop a treatment plan suited to your needs.
What treatment options are available?
Most cases of calcific tendonitis can be treated without surgery. In mild cases, your doctor may recommend a mix of medication and physical therapy or a nonsurgical procedure.
Medication
Nonsteroidal anti-inflammatory drugs (NSAIDs) are considered to be the first line of treatment. These medications are available over the counter.
Your doctor may also recommend corticosteroid (cortisone) injections to help relieve any pain or swelling.
Nonsurgical procedures
In mild-to-moderate cases, your doctor may recommend one of the following procedures. These conservative treatments can be carried out in your doctor’s office.
Extracorporeal shock-wave therapy (ESWT): Your doctor will use a small handheld device to deliver mechanical shocks to your shoulder, near the site of calcification.
Higher frequency shocks are more effective, but can be painful, so speak up if you’re uncomfortable. Your doctor can adjust the shock waves to a level you can tolerate.
This therapy may be performed once a week for three weeks.
Radial shock-wave therapy (RSWT): Your doctor will use a handheld device to deliver low- to medium-energy mechanical shocks to the affected part of the shoulder. This produces effects similar to ESWT.
Therapeutic ultrasound: Your doctor will use a handheld device to direct a high frequency sound wave at the calcific deposit. This helps break down the calcium crystals and is usually painless.
Percutaneous needling: This therapy is more invasive than other nonsurgical methods. After administering local anesthesia to the area, your doctor will use a needle to make small holes in your skin. This will allow them to manually remove the deposit. This may be done in conjunction with ultrasound to help guide the needle into the correct position.
Surgery
About 10 percent of people will need surgery to remove the calcium deposit.
If your doctor opts for open surgery, they’ll use a scalpel to make an incision in the skin directly above the deposit’s location. They’ll manually remove the deposit.
If arthroscopic surgery is preferred, your doctor will make a small incision and insert a tiny camera. The camera will guide the surgical tool in removal of the deposit.
Your recovery period will depend on the size, location, and number of calcium deposits. For example, some people will return to normal functioning within the week, and others may experience post-surgical pain that continues to limit their activities. Your doctor is your best resource for information about your expected recovery.
What to expect from physical therapy
Moderate or severe cases typically require some form of physical therapy to help return your range of motion. Your doctor will walk you through what this means for you and your recovery.
Rehabilitation without surgery
Your doctor or physical therapist will teach you a series of gentle range-of-motion exercises to help restore movement in the affected shoulder. Exercises such as the Codman’s pendulum, with slight swinging of the arm, are often prescribed at first. Over time, you’ll work up to limited range-of-motion, isometric, and light weight-bearing exercises.
Rehabilitation after surgery
Recovery time after surgery varies from person to person. In some cases, full recovery may take three months or longer. Recovery from arthroscopic surgery is generally quicker than from open surgery.
After either open or arthroscopic surgery, your doctor may advise you to wear a sling for a few days to support and protect the shoulder.
You should also expect to attend physical therapy sessions for six to eight weeks. Physical therapy usually begins with some stretching and very limited range-of-motion exercises. You’ll typically progress to some light weight-bearing activity about four weeks in.
Outlook
Although calcific tendonitis can painful for some, a quick resolution is likely. Most cases can be treated in a doctor’s office, and only 10 percent of people require some form of surgery.
Calcific tendonitis does eventually disappear on its own, but it can lead to complications if left untreated. This includes rotator cuff tears and frozen shoulder (adhesive capsulitis).
There isn’t any evidence to suggest that calcific tendonitis is likely to recur, but periodic checks are recommended.